The objectives of this study are to identify changes in neural responses to alcohol cues among adolescents undergoing treatment for alcohol use disorders (AUD) beyond what would be attributable to repeat testing or abstinence alone. A second objective is to investigate the predictive value of blood oxygen level dependent (BOLD) response to alcohol cues on post-treatment relapse among adolescents with AUD. This information can be of great use for research development to tailor alcohol treatment programs to youth with elevated alcohol cue reactivity, and for making treatment discharge decisions based on cue response-related risk for relapse. The specific aims of this project are to: 1) examine differences in BOLD response to alcohol cues in a sample of adolescents with AUD from before to after treatment and as compared to a matched non-treatment- seeking group of adolescents with AUD abstinent for a similar period of time;and 2) examine, in the treatment group, the predictive utility of post-treatment alcohol cue BOLD response on relapse-related measures. The methods consists of recruiting 2 groups of adolescents with AUD (N=40) ages 15 to 17, from both genders and all ethnicities. The treatment group (n=20) will consist of adolescents with AUD enrolled and actively participating in a 4-week community-based outpatient treatment program for alcohol and other substance use disorders. The abstinence-only comparison group (n=20) will consist of age-, gender-, ethnicity-, socioeconomic-, and family history for AUD-matched adolescents with AUD but non treatment-seeking, abstinent for an equivalent period of time and recruited from within the same ZIP codes of residence as the treatment group. Adolescent participants and one of their parents or legal guardians will undergo a semi- structured interview to ascertain adolescents'AUD diagnosis, substance use rates, and eligibility criteria. Within the first week of treatment/abstinence, participants will have a first neuroimaging session (MRI1) with the alcohol cue reactivity task developed by the PI (Pulido, Brown, Cummins, Paulus, &Tapert, 2009). During the following 4 weeks, participants will be contacted twice per week to complete brief questionnaires on substance use and provide breath and urine samples for breathalyzer and toxicology testing to ascertain alcohol and other substance use abstinence. After a 4-week period of treatment and abstinence, or abstinence alone, participants will complete a second neuroimaging session (fMRI2) including the alcohol cue reactivity task. Participants will then be contacted after 3 (FU1) and 5 (FU2) months since fMRI1, to inquire about alcohol and other substance involvement. Methods Screen &Interview fMRI1 fMRI2 FU1 FU2 Time (weeks) .5 1 5 13 21 PUBLIC HEALTH RELEVANCE: This research will examine the ability of a 4-week community-based substance treatment to modify AUD adolescents'brain responses to alcohol-related images beyond the effect of abstinence alone. Additionally, it will be examined whether greater post-treatment brain response to alcohol pictures predicts an increased chance for and severity of relapse after treatment. This information can be of great use for developing future research studies to help tailor treatment for adolescents with elevated reactions to alcohol images.